Trial reportJACC. Cardiovascular imaging2019
A Comparison of the Updated Diamond-Forrester, CAD Consortium, and CONFIRM History-Based Risk Scores for Predicting Obstructive Coronary Artery Disease in Patients With Stable Chest Pain: The SCOT-HEART Coronary CTA Cohort.
Trial report in JACC. Cardiovascular imaging, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 3 of them syntheses that pooled it.
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Who cites it
38 citing papers in PubMed, 3 syntheses or guidelines pooled it, 60 citations in OpenAlex.
- Comparing machine learning models and traditional approaches for predicting obstructive coronary artery disease: a systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2026Pooled it
- Pooled it
- SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography.Journal of cardiovascular computed tomographyGuideline
- Clinical pre-test probability for obstructive coronary artery disease: insights from the European DISCHARGE pilot study.European radiology · 2021Trial
- Are risk factors necessary for pretest probability assessment of coronary artery disease? A patient similarity network analysis of the PROMISE trial.Journal of cardiovascular computed tomographyTrial
- Great debate: the new risk factor-weighted clinical likelihood model is useful to estimate the initial pre-test probability of obstructive coronary artery disease in individuals with suspected chronic coronary syndromes.European heart journal · 2026Article
- Validity of the 2019 European Society of Cardiology Pre-Test Probability (2019 ESC-PTP) for predicting obstructive coronary artery disease among Malaysians.Scientific reports · 2026Article
- The Long March to Identify Patients With Coronary Artery Disease by Pretest Probability Model.JACC. Asia · 2025Article
- Developing an ML-Based Pretest Probability Model of Obstructive CAD in Patients With Stable Chest Pain.JACC. Asia · 2025Article
- Deep learning on electrocardiogram waveforms to stratify risk of obstructive stable coronary artery disease.European heart journal. Digital health · 2025Article
- Comparative Evaluation of Pre-Test Probability Models for Coronary Artery Disease with Assessment of a New Machine Learning-Based Model.Yonsei medical journal · 2025Article
- The predictive value of coronary artery calcium score combined with traditional risk factors for obstructive coronary heart disease in young people.BMC cardiovascular disorders · 2024Article
- Evaluating the American Heart Association/American College of Cardiology Guideline-Recommended and Contemporary Pretest Probability Models in a Mixed Asian Cohort: The Contribution of Coronary Artery Calcium.Journal of the American Heart Association · 2024Article
- Approach to acute chest pain and acute coronary syndrome in adults.Singapore medical journal · 2024Article
- Simplified Approach to Predicting Obstructive Coronary Disease With Integration of Coronary Calcium: Development and External Validation.Journal of the American Heart Association · 2023Article
- Impact of cardiac history and myocardial scar on increase of myocardial perfusion after revascularization.European journal of nuclear medicine and molecular imaging · 2023Article
- Predictive value of machine learning algorithm of coronary artery calcium score and clinical factors for obstructive coronary artery disease in hypertensive patients.BMC medical informatics and decision making · 2023Article
- Machine learning approaches that use clinical, laboratory, and electrocardiogram data enhance the prediction of obstructive coronary artery disease.Scientific reports · 2023Article
- Clinical Application of Myocardial Perfusion SPECT in Patients with Suspected or Known Coronary Artery Disease. What Role in the Multimodality Imaging Era?Reviews in cardiovascular medicine · 2023Review
- Comparison of risk assessment strategies incorporating coronary artery calcium score with estimation of pretest probability to defer cardiovascular testing in patients with stable chest pain.BMC cardiovascular disorders · 2023Article
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Authors and funding
11 authors at 3 institutions in 2 countries.
Funding
Abstract
objectivesThis study sought to compare the performance of history-based risk scores in predicting obstructive coronary artery disease (CAD) among patients with stable chest pain from the SCOT-HEART study.
backgroundRisk scores for estimating pre-test probability of CAD are derived from referral-based populations with a high prevalence of disease. The generalizability of these scores to lower prevalence populations in the initial patient encounter for chest pain is uncertain.
methodsWe compared 3 scores among patients with suspected CAD in the coronary computed tomographic angiography (CTA) randomized arm of the SCOT-HEART study for the outcome of obstructive CAD by coronary CTA: the updated Diamond-Forrester score (UDF), CAD Consortium clinical score (CAD2), and CONFIRM risk score (CRS). We tested calibration with goodness-of-fit, discrimination with area under the receiver-operating curve (AUC), and reclassification with net reclassification improvement (NRI) to identify low-risk patients.
resultsIn 1,738 patients (age 58 ± 10 years and 44.0% women), overall calibration was best for UDF, with underestimation by CRS and CAD2. Discrimination by AUC was highest for CAD2 at 0.79 (95% confidence interval [CI]: 0.77 to 0.81) than for UDF (0.77 [95% CI: 0.74 to 0.79]) or CRS (0.75 [95% CI: 0.73 to 0.77]) (p < 0.001 for both comparisons). Reclassification of low-risk patients at the 10% probability threshold was best for CAD2 (NRI 0.31, 95% CI: 0.27 to 0.35) followed by CRS (NRI 0.21, 95% CI: 0.17 to 0.25) compared with UDF (p < 0.001 for all comparisons), with a consistent trend at the 15% threshold.
conclusionsIn this multicenter clinic-based cohort of patients with suspected CAD and uniform CAD evaluation by coronary CTA, CAD2 provided the best discrimination and classification, despite overestimation of obstructive CAD as evaluated by coronary CTA. CRS exhibited intermediate performance followed by UDF for discrimination and reclassification.
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